Geographic Distribution of Racial Differences in Prostate Cancer Mortality
Geographic Distribution of Racial Differences in Prostate Cancer Mortality
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DOI：
10.1001/jamanetworkopen.2020.1839
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发表时间：
2020-03-31
影响因子：
13.8
通讯作者：
Quoc-Dien Trinh
中科院分区：
文献类型：
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作者：
Fletcher, Sean A.;Marchese, Maya;Quoc-Dien Trinh
重要性虽然前列腺癌死亡率的种族差异有很好的记录，但在美国，这些差异在地理上是如何变化的还不清楚。目的描述黑人和白色男性前列腺癌特异性死亡率差异的地理差异。设计、设置和参与者本队列研究包括2007年1月1日至2014年12月31日监测、流行病学和最终结果（SEER）数据库中17个地理注册中心的数据。入选标准为18岁及以上经活检证实的前列腺癌男性。排除了关键变量（即癌症分期、Gleason分级组、前列腺特异性抗原水平和生存随访数据）数据缺失的男性。分析时间为2018年9月5日至12月25日。暴露患者SEER指定的人种（即黑人、白色或其他）。主要结果和测量精细和灰色竞争风险回归分析被用来评估黑人和白色男性之间前列腺癌特异性死亡率的差异。按Gleason分级组进行分层分析，分层为1级组和2 - 5级组。结果最终队列包括229 771名男性，其中白色男性178 204人（77.6%），黑人男性35 006人（15.2%），其他人种或未知人种16 561人（7.2%）。诊断时的平均（SD）年龄为64.9（8.8）岁。白色男性中有4773例前列腺癌死亡，黑人男性中有1250例前列腺癌死亡。与白色男性相比，黑人男性的总体死亡风险更高（调整后的风险比[AHR]，1.39 [95%CI，1.30-1.48]）。在分层分析中，有4个登记研究中，黑人男性在Gleason分级组1和Gleason分级组2中的前列腺癌特异性生存率均较差。（亚特兰大，格鲁吉亚：AHR，5.49 [95% CI，2.03-14.87];大格鲁吉亚：AHR，1.88 [95% CI，1.10-3.22];路易斯安那：AHR，1.80 [95% CI，1.06-3.07];新泽西：AHR，2.60 [95% CI，1.53-4.40]）和Gleason分级组2 - 5（亚特兰大：AHR，1.88 [95% CI，1.46-2.45];大格鲁吉亚：AHR，1.29 [95% CI，1.07-1.56];路易斯安那：AHR，1.28 [95% CI，1.07-1.54];新泽西：AHR，1.52 [95% CI，1.24-1.87]），尽管在这些登记研究中，生存差异的幅度低于Gleason 1级组。在亚特兰大登记研究中，Gleason分级1组疾病男性的最大种族生存差异。结论和相关性这些发现表明，黑人和白色男性前列腺癌生存率的人群水平差异与一小部分地理区域和低风险前列腺癌相关。在这些领域进行有针对性的干预可能有助于减轻国家层面的前列腺癌治疗差异。问题：在美国，前列腺癌预后的种族差异在地理上有何不同？调查结果在这项针对监测、流行病学和最终结果数据库中17个地理登记处的229 & x202 f;771名男性的队列研究中，黑人男性的总体死亡风险高于白色男性。在格鲁吉亚亚特兰大登记处的低风险前列腺癌男性中，基于种族的生存差异最大，黑人男性的死亡风险增加了5倍以上。这些研究结果表明，基于种族的前列腺癌生存率差异在不同地区，这可能允许有针对性的干预措施，以减轻这些disparity.This队列研究探讨前列腺癌死亡率的差异，在白色与黑人男性分层的地理区域。
Importance While racial disparities in prostate cancer mortality are well documented, it is not well known how these disparities vary geographically within the US. Objective To characterize geographic variation in prostate cancer-specific mortality differences between black and white men. Design, Setting, and Participants This cohort study included data from 17 geographic registries within the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2007, to December 31, 2014. Inclusion criteria were men 18 years and older with biopsy-confirmed prostate cancer. Men missing data on key variables (ie, cancer stage, Gleason grade group, prostate-specific antigen level, and survival follow-up data) were excluded. Analysis was performed from September 5 to December 25, 2018. Exposure Patient SEER-designated race (ie, black, white, or other). Main Outcomes and Measures Fine and Gray competing-risks regression analyses were used to evaluate the difference in prostate-cancer specific mortality between black and white men. A stratified analysis by Gleason grade group was performed stratified as grade group 1 and grade groups 2 through 5. Results The final cohort consisted of 229 & x202f;771 men, including 178 & x202f;204 white men (77.6%), 35 & x202f;006 black men (15.2%), and 16 & x202f;561 men of other or unknown race (7.2%). Mean (SD) age at diagnosis was 64.9 (8.8) years. There were 4773 prostate cancer deaths among white men and 1250 prostate cancer deaths among black men. Compared with white men, black men had a higher risk of mortality overall (adjusted hazard ratio [AHR], 1.39 [95% CI, 1.30-1.48]). In the stratified analysis, there were 4 registries in which black men had worse prostate cancer-specific survival in both Gleason grade group 1 (Atlanta, Georgia: AHR, 5.49 [95% CI, 2.03-14.87]; Greater Georgia: AHR, 1.88 [95% CI, 1.10-3.22]; Louisiana: AHR, 1.80 [95% CI, 1.06-3.07]; New Jersey: AHR, 2.60 [95% CI, 1.53-4.40]) and Gleason grade groups 2 through 5 (Atlanta: AHR, 1.88 [95% CI, 1.46-2.45]; Greater Georgia: AHR, 1.29 [95% CI, 1.07-1.56]; Louisiana: AHR, 1.28 [95% CI, 1.07-1.54]; New Jersey: AHR, 1.52 [95% CI, 1.24-1.87]), although the magnitude of survival difference was lower than for Gleason grade group 1 in each of these registries. The greatest race-based survival difference for men with Gleason grade group 1 disease was in the Atlanta registry. Conclusions and Relevance These findings suggest that population-level differences in prostate cancer survival among black and white men were associated with a small set of geographic areas and with low-risk prostate cancer. Targeted interventions in these areas may help to mitigate prostate cancer care disparities at the national level.Question How do race-based disparities in prostate cancer outcomes differ geographically within the US? Findings In this cohort study of 229 & x202f;771 men in 17 geographic registries within the Surveillance, Epidemiology, and End Results database, black men had a higher risk of mortality overall compared with white men. The greatest race-based survival difference was seen in men with low-risk prostate cancer in the Atlanta, Georgia, registry, where mortality risk among black men was increased more than 5-fold. Meaning These findings suggest that race-based survival differences in prostate cancer vary regionally, which may allow for targeted interventions to mitigate these disparities.This cohort study examines differences in prostate cancer mortality in white vs black men stratified by geographic region.